Biomedical subjects

T Luiz

Publications and source records attributed to T Luiz.

12 recordsLinked to original sources

PubMed2001

[Optimized logistics in the prehospital management of acute stroke].

OBJECTIVE: Current management of acute stroke is characterised by an aggressive approach including specific therapy i. e. reperfusion therapy. However currently stroke patients often arrive too late in hospitals offering adequate treatment. Therefore optimized logistics play a predominant role in modern stroke management. AIMS OF THE STUDY: 1. Does teaching of EMS staff and the public result in reduced prehospital latencies 2. Will EMS personnel be able to effectively screen patients potentially suitable for thrombolysis? METHODS: During a six week-period all EMS patients presenting with possible signs of an acute stroke were prospectively registered (period 1). Data of interest were age, mode of primary contact, prehospital latencies, mode of transportation, destination and final diagnosis. Next an algorithm was established allowing EMS personnel to transfer patients with an assumed stroke to the best suitable hospital. Teaching comprised clinical signs, indication of CT scanning, pathophysiology, specific therapeutic options (thrombolysis), and criteria to identify patients suitable for thrombolysis. In a second step the public was continuously taught about stroke symptoms and the necessity to instantly seek EMS assistance. After 12 months data were compared to baseline (period 2). RESULTS: (period 2 vs. Period 1): Rate of patients transferred to a stroke center: 60 % vs. 54 %; rate of those transported to hospitals not offering CT scans: 17 % vs. 26 % (p < 0.05). Percentage of patients primarily contacting the EMS system: 33 % vs. 24 %. Median interval between onset of symptoms and emergency call: 54 vs. 263 minutes Median interval between the emergency call and arrival at the emergency department: 44 vs. 58 minutes (p < 0.01). Rate of patients admitted with a diagnosis other than stroke: 18 % vs. 25 % (n. s.). Median interval between onset of symptoms and hospital admission: 140 vs. 368 minutes (p < 0.001). Median age: 69 vs. 75 years (p < 0.01). CONCLUSION: This study demonstrates the efficacy of educational efforts in reducing latencies and in screening patients potentially suitable for thrombolysis. Future efforts will comprise more intense education of a high risk subpopulation.

Age Factors↗

PubMed2001

Hypertonic-hyperoncotic solutions decrease cardiac troponin I concentrations in peripheral blood in a porcine ischemia-reperfusion model.

In this study we addressed the question of whether the measurement of cardiac Troponin I (cTnI) is able to reflect beneficial effects of hypertonic-hyperoncotic solutions after transient cardiac arrest. Ten pigs were anaesthetized and cardiac arrest was induced by electric fibrillation. After 5 minutes of global ischemia, cardiac arrest was reversed by electric defibrillation. Upon return of spontaneous circulation 5 animals received hypertonic-hyperoncotic solutions (10% Hydroxyethylstarch 200/0.5 and 7.2% NaCl). The other animals received equivalent volumes of physiological saline. We observed that cTnI serum levels of animals treated with hypertonic-hyperoncotic solutions were significantly lower than those treated with saline. We conclude that hypertonic-hyperoncotic solutions may have cardioprotective effects.

Animals↗

PubMed2000

Cardiac troponin I and cardiac troponin T increases in pigs during ischemia-reperfusion damage.

In this study we addressed the question of whether the measurement of cardiac Troponin T (cTnT) and cardiac Troponin I (cTnI) is able to detect myocardial cell damage in an ischemia-reperfusion model in pigs. To answer the question 3 pigs were anaesthesized and a cardiac arrest was induced by electric fibrillation. After 5 minutes of global ischemia the cardiac arrest was reversed by electric defibrillation until normal perfusion was restored. We could clearly demonstrate an increase of cTnT and cTnI 30 minutes after reperfusion indicating myocardial injury during ischemia and subsequent reperfusion. The cTnT as well as the cTnI serum levels increased till 180 minutes after reperfusion. This ischemia-reperfusion injury is likely induced by oxygen radicals generated during hypoxia and subsequent reperfusion We conclude from our first results that troponin measurements with commercial available test kits may also reflect myocardial cell damage in pigs as it was recently demonstrated in rats. Further studies are needed for correlation of troponin serum levels and histopathological damage in this model especially if it is used to test beneficial or toxicological effects of radical neutralizing drugs.

Animals↗

PubMed1999

Perioperative ST-segment depression and troponin T release. Identification of patients with highest risk for myocardial damage.

BACKGROUND: Patients undergoing major vascular surgery are at constant risk of developing perioperative myocardial complications, especially myocardial infarction. The following study was performed to answer the question whether ST segment changes, analysed by Holter monitoring and ST segment analysis, are accompanied by release of cardiac troponin T, a highly specific marker of myocardial damage. METHODS: Twenty patients undergoing elective aortic resection were studied by performing Holter ECG, including ST segment analysis, beginning on the evening before surgery until the third postoperative day. Within this period serum levels of cardiac troponin T were determined at 8 timepoints. RESULTS: A total of 8/20 of the patients (40%) showed significant ST depressions (range -0.17/-0.68 mV), without any clinical symptom, with a median of 9 episodes (range 2-24). In 3 of the 8 patients, each with repetitive periods of ST depression, elevated troponin T levels were found (0.45/0.52/1.69 micrograms/l). No troponin T release nor cardiac events were noticed in the remaining patients. No dependency could be found between troponin T release and the magnitude of ST depression or the number of ST depression episodes. CONCLUSION: Haemodynamic changes, oxygen imbalance and stress during major vascular surgery frequently lead to an ischaemic burden, which is indicated by ST segment changes during ECG ST analysis. Longlasting ST depression reaching an individual critical cut-off limit followed by structural myocardial damage may be verified by elevated levels of cardiac troponin T. Prolonged periods of ST depression should be followed by determination of cardiac troponin T.

Aged↗

PubMed1999

[Horizontal deceleration trauma with diffuse decollement bleeding--a casuistry].

Treatment of severe haemorrhage caused by multiple trauma is a serious challenge to preclinical as well as clinical management. This is a case report of a motorcycle accident in which a patient sustained total amputation of both legs. Following adequate preclinical care, vital indication led to the patient's immediate surgical treatment. After initially successful haemodynamic stabilisation, the patient developed a horizontal deceleration trauma which resulted in an extended decollement of the muscles of the back and buttock. During the further clinical course, soft tissue bleeding occurred that affected the whole torso. Due to its extent, the bleeding could not be treated surgically, nor did it allow of haemodynamic stabilisation despite continuous massive transfusion. Retrospectively, the impressing amputation injury was treated successfully. In spite of all available surgical and intensive care efforts, however, the slowly demasking monstrous decollement with diffuse tissue bleeding proved to be an injury pattern leading to the patient's death.

Accidents, Traffic↗

PubMed1998

[Evaluation of a rapid qualitative test for cardiac troponin T in clinical diagnosis of patients with acute coronary syndrome].

OBJECTIVE: To evaluate the practical performance and the diagnostic power of a rapid, qualitative assay for the detection of cardiac Troponin T (indicated cut-off level: 0.3 ng/ml) in EMS patients presenting with acute myocardial ischemia. PATIENTS: 145 consecutive patients with non-traumatic chest pain treated by the Mobile Intensive Care Unit team. During phase 1 (73 patients), blood drawn at the emergency site was used to perform a Troponin T rapid assay under defined conditions at the hospital. During phase 2 (72 patients), the rapid assay was already performed at the emergency site. RESULTS: In phase 1 all tests were performed correctly, whereas 5.6% of the test results had to be declared invalid in phase 2. 17 (11.7%) of the 145 patients showed a positive test result. Analytic sensitivity was 100%, specificity 96.3%. 37 of the 145 patients (median duration of symptoms: 150 minutes) showed a myocardial infarction (MI). Related to the diagnosis of MI diagnostic sensitivity, specificity, positive and negative predictive values were 35.1, 96.3, 76.5, and 81.3%. Mortality in patients with a positive rapid assay was 35.3%, compared to 6.3% in patients with a negative test result (p < 0.001). CONCLUSIONS: The rapid assay allows the detection of Troponin T in concentrations above the cut-off level. Meticulous observance of the manufacturer's rules is imperative. A single preclinical rapid assay does not allow to exclude a MI. However, the test enables EMS personnel to identify patients who are at increased risk of dying from an acute coronary syndrome in the immediate future.

Aged↗

PubMed1997

[Optimized documentation entry in emergency care using pen computers--initial results].

PURPOSE: Recently, documentation systems based on portable personal computers have become available for application in prehospital emergency medicine. The aim of the present study was to compare a handwritten record system with a pen-computing assisted documentation system. METHODS: 52 consecutive jobs of the local mobile intensive care unit (MICU) were recorded both by means of a handwritten record and by use of a pen-computer-assisted documentation system (NAPROT, based on DIVI-documentation system version 2.5). The paramedic performing pen-computing was obliged to restrict data inputs to those moments during which emergency physician was able to fill in his record. NAPROT routinely checked the records derived from the pen-computer for completeness of data before print-out. RESULTS: Neither hardware nor software problems occurred. Compared to the handwritten records the electronic documentation system resulted in a significant increase in recorded data. The following parameters were recorded more frequently by means of the new method of documentation: Glasgow Coma Score (47 vs 36 patients), positioning manoeuvres (36 vs 19 patients), blood glucose level (25 vs 17 patients), and complications (13 vs. 4 events). CONCLUSION: Pen-computing assisted documentation resulted in superior quality of data recorded in emergency medical files. This increase in information may be ascribed to the integrated check for completeness of data. The described new documentation system, therefore, enhances the processing quality in prehospital emergency medicine. Further developments of the documentation system should concentrate on tools while reducing the workload of the emergency physician.

Ambulances↗

PubMed1997

[Prehospital management of emergency patients after previous treatment by general practitioners--a prospective study].

INTRODUCTION: In Germany emergency patients are currently treated both by certified emergency physicians as well as by family doctors and general practitioners. METHODS: 1.) We evaluated the cooperation between the regional rescue service centres of the general practitioners' acute response service and the EMS system in Baden-Württemberg, a German "Land" (province), with about 10 million inhabitants. 2.) We analysed the management of patients who had been initially treated by the general practitioners' acute response service or by family doctors and had then to be further stabilised by the emergency physicians of our mobile intensive care unit (MICU). RESULTS: 1.) Joint rescue service centres of the two organisations exist in only 12 of a total of 37 areas. Although lacking adequate emergency equipment, practitioners often treat vitally compromised patients without the assistance of the EMS system. 2.) 97 out of 105 jobs were further analysed (acute response service: n = 45; family doctors: n = 52). Suspected myocardial infarction (n = 32) and acute heart failure (n = 15) were the most common emergencies. Emergency management before the emergency physician arrived often did not meet common standards (lack of ECG monitoring, oxygen treatment, venous access, pain relief). Until the emergency physician arrived 40% of the patients had been left alone by their doctor. Moreover, medical documentation had to be classified as insufficient in 70%. CONCLUSIONS: Prehospital treatment of medical emergencies is impeded by the lack of cooperation between the involved organisations. Family doctors and general practitioners should not treat emergencies without the help of the local MICU. Solutions of these problems are presented.

Documentation↗

PubMed1996

Active compression-decompression cardiopulmonary resuscitation does not improve survival in patients with prehospital cardiac arrest in a physician-manned emergency medical system.

OBJECT: To examine the efficacy of a new method of cardiac resuscitation, active compression-decompression cardiopulmonary resuscitation (ACD CPR), in prehospital cardiac arrest. DESIGN: Prospective, randomized, controlled trial. SETTING: Physician-manned Mobile Intensive Care Unit (MICU) of a university hospital, serving a population of 200,000. PARTICIPANTS: Adult patients with prehospital nontraumatic cardiac arrest treated by the MICU. INTERVENTIONS: Patients were randomized to standard chest compression according to American Heart Association (AHA) recommendations (group 1, 30 patients) or to the new technique (group 2, 26 patients). ACD was performed by use of a hand-held suction device. In both groups, advanced life support was performed as recommended by the AHA. MEASUREMENTS AND MAIN RESULTS: Rate of patients regaining a spontaneous circulation (ROSC), hospital discharge rate, and mean carbon dioxide content during resuscitation were recorded. ROSC rates in groups 1 and 2 were 40% and 38.5%, respectively. Four patients (13.3%) in group 1 and three patients (11.5%) in group 2 were discharged (group 1 v group 2: n.s.). Anatomic conditions precluded the application of ACD CPR in 5 patients. The new technique was found to impose greater physical efforts than STD CPR. Capnography was performed in 23 patients (mean value: STD CPR: 11.9 +/- 4.7 mmHg, ACD CPR: 13.7 +/- 4.9 mmHg [n.s.]). CONCLUSIONS: ACD CPR did not improve, outcome and practical performance was complicated. Therefore, this technique should not be performed routinely, or without strict supervision in prehospital cardiac arrest.

Adult↗

PubMed1994

[Randomized use of an active compression-decompression technique within the scope of preclinical resuscitation].

INTRODUCTION: Despite its worldwide propagation, external chest compression is of limited efficacy. Recently a new method of cardiac resuscitation, active compression-decompression (ACD), was presented. In animals and a small series of patients resuscitated within the hospital ACD proved to augment blood flow during cardiac resuscitation as a result of greater intrathoracic pressure gradients. AIM OF THE STUDY: We investigated whether ACD does provide superior survival in patients suffering from out-of-hospital cardiac arrest. METHODS: Doctors and paramedics of the mobile intensive care unit at Mannheim University Hospital were trained in the new method. 56 patients were randomly assigned to either standard chest compression according to recommendations of the American Heart Association, AHA (Group I, 30 patients) or to ACD (Group II, 26 patients). ACD was performed by use of a hand-held suction device (CardioPump, Ambu Int.). Compression (30-50 kp) and decompression (10-15 kp) were alternately applied to the patients' chest with a frequency of 80/min. Duration of compression was 50% of the cycle. In both groups advanced life support was performed according to AHA standards. RESULTS: In Group I, 40% of the patients could be resuscitated; and 13.3% were discharged from hospital. In Group II, 38.5% of the patients regained spontaneous circulation, and 11.5% of the patients were discharged. (Group I vs. Group II: n.s.). One patient in each group survived with a severe neurological deficit. ACD caused greater physical efforts than standard chest compression. Furthermore ACD was difficult to perform in patients with ventricular fibrillation once electrode gel had been used. ACD was not feasible in five patients because of large breast (four women) and kyphoscoliosis (one patient). The rate of serious complications was lower in Group II. CONCLUSIONS: Methods to verify the efficacy of ACD in dummy training should be developed. Paramedics performing ACD should relieve each other every 5 minutes. In patients resuscitated by ACD self-adhesive defibrillation paddles instead of electrode gel should be used. Modifications in the design of the CardioPump are desirable to enhance the efficacy of ACD. With regard to future multicentre trials all paramedics should be skilled in the new technique to reach more patients in a shorter period of time.

Adult↗

PubMed1992

[Ventilatory changes during laparoscopic cholecystectomy].

During the past 2 years in Europe and the USA laparoscopic cholecystectomy (LC) has become a widely practiced procedure. Nevertheless, the effects of long-lasting laparoscopic procedures on carbon dioxide elimination have not yet been systematically investigated. METHODS. Approval from the institutional research review board was obtained, as was written informed consent from the patients. Eleven patients undergoing LC were studied. Patient age ranged from 31 to 67 years. All patients received total intravenous anaesthesia (fentanyl, propofol, vecuronium, DHB). Controlled ventilation with a tidal volume of 12-14 ml/kg was administered. Before introduction of anaesthesia a cannula was inserted into the left radial artery. Blood gas analysis was undertaken just before introduction, just before insufflation of carbon dioxide, and thereafter at two intervals, after reaching an intra-abdominal pressure of 12 mm Hg, 15 min apart. Oxygen consumption and carbon dioxide output were measured using a calorimeter (Deltatrac TM, Datex). Intra-abdominal pressure was maintained at 12 mm Hg during the operation. RESULTS. After onset of the pneumoperitoneum inspiratory peak and plateau pressure showed an increase by more than 40%. During the operation respiratory minute volume had to be increased by about 30-40% to maintain normocapnia. Oxygen consumption remained nearly unchanged during the procedure while carbon dioxide output increased up to 38% 60 min after onset of the pneumoperitoneum. D(a-A) CO2 showed no significant change, indicating no increase in dead space. Beginning with the insufflation there was a significant increase in mean arterial pressure that lasted until the end of the procedure. CONCLUSION. The described effects of carbon dioxide insufflation, especially the extent of carbon dioxide resorption, define the need for careful monitoring of respiratory function during LC, especially in patients with preexisting cardiopulmonary disease.

Adult↗

PubMed1992

[Total spinal anesthesia. A complication of lumbar catheter peridural anesthesia for postoperative analgesia].

A case of secondary subarachnoidal dislocation of a lumbar epidural catheter is reported. A 76-year-old female underwent resection of the sigmoid colon. In order to provide postoperative analgesia, an epidural catheter was inserted between the 3rd and 4th lumbar interspaces prior to induction of anaesthesia. Aspiration tests were negative twice and a test dose of 4 ml 0.5% bupivacaine produced no signs of anaesthesia. Thereafter, the operation was performed under balanced general anaesthesia. Prior to the end of surgery a total of 14 ml bupivacaine 0.5% was administered without significant cardiovascular depression. At the time of extubation the patient was awake and free of pain. There was no sign of respiratory depression or paralysis of the upper extremities. Three hours later in the recovery room the patient complained of pain. After a negative aspiration test 14 ml bupivacaine 0.25% was injected. Thirty minutes after injection apnea and cardiac arrest occurred. Resuscitation was immediately started, resulting in quick restoration of circulation and restitutio ad integrum. Aspiration at this time showed cerebrospinal fluid. The latency of the onset of total spinal anaesthesia and the rapid restoration of stable vital functions, was astonishing. It is essential to observe the common precautions such as an aspiration test without a filter, administration of a test dose, and titration of the injected amount each time the anaesthetic agent is applied via an epidural catheter.

Aged↗